Job Details

Pharmacist Job Description

The Clinical Specialist manages the accessibility, quality, and cost-effectiveness of drug and medical therapy for members and providers. This position focuses on initiating, supporting, and continuing cost-effective, rational drug, and disease therapy through distinct but inter-related management and cross-departmental functions.

Responsibilities:

• Provide clinical support services to client plans contracting for clinical services.
• Conduct clinical reviews, analyses, recommendations, decisions, and documentation of prior authorization requests, medical exception requests, and appeal requests as required by client contracts and Utilization Management delegation agreements.
• Review medication request guidelines for clinical appropriateness and operational efficiency.
• Assist in revising and creating new or existing medication request guidelines.
• Provide drug information support and research clinical literature documentation to support prior authorization decisions.
• Prepare Pharmacy and Therapeutics meeting agenda and associated meeting materials, including clinical and financial reviews of individual drugs, drug classes, and current therapy for specific disease states and drug formulary review.
• Coordinate and assist in the preparation of utilization and compliance reporting for client plans.
• Ensure timely preparation and review of plan data and client presentations, when required.
• Coordinate and assist with projects associated with prior authorization program development, implementation, and internal and external communications.
• Provide feedback to Prior Authorization Coordinators (PACs) regarding the processing of PA cases referred for clinical review.
• Provide in-service education to PACs regarding topics such as PA guidelines, diagnoses commonly seen as part of the PA review process.

Essential Skills:

• Pharmacy degree (Pharm. D.) or equivalent.
• Unrestricted license in the state of residence.
• Five (5) plus years of related experience and/or training, or an equivalent combination of education and experience.
• Knowledge of Medicaid.
• Experience in Pharmacy Benefits Management (PBM) is preferred.
• Experience in retail, hospital, or long-term care settings is beneficial.
• Expertise in clinical application of pharmacy practice.

Additional Skills & Qualifications:

• Experience with MTM, Medicare, Retail pharmacy, Medicaid, Insurance verification, and Pharmacy benefits management.
• Proficient in Microsoft Office Suite Word Processing software.
• Excellent working knowledge of all types of pharmacy services with an emphasis on the managed health care environment.
• Current, unrestricted Registered Pharmacist license.

Work Environment:

This is a completely remote work-from-home position. Candidates do not need to live near the work site but must have an active license in the state they reside. A quiet workspace and a high-speed internet connection are required. Shifts are rotated, with options from 9 am-6 pm MST or between 11 am-11 pm MST. Candidates must be able to work either 11 am-7:30 pm MST or 2:30 pm-11 pm MST. Benefits include Medical, Dental, Vision, Wellness Programs, Paid Time Off, Company Paid Holidays, Incentive Compensation, 401K with Company match, Life and Disability Insurance, Tuition Reimbursement, and Employee Referral Bonus.

Job Type & Location:

This is a Contract to Hire position based out of Tempe, Arizona. Pay and Benefits The pay range for this position is $61.75 - $61.75/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms.

About Actalent:

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.